On August 7th, I put Max down for his morning nap, grabbed my breast pump and sat on the sofa. I looked at the pump and suddenly was filled with dread. I really didn’t want to do this again. It was such a drag to sit there for 20 minutes for the smallest amount of milk. Such a bore, so much effort. Was it really worth it to keep going?
At this point, for a number of reasons, I had stopped nursing Max and was only pumping twice a day. I wasn’t getting much milk. Every two days I had enough to feed him a full bottle. I was over it. It didn’t feel worthwhile.
I started to cry. It was so hard to give this up, even at this scaled back point. I realized that I wanted to, so badly, but I felt immense guilt over not giving Max breastmilk for at least the first 6 months of his life. It brought up all the pain I experienced in the first few weeks (months in fact) of his life when I realized I wouldn’t be able to fully breastfeed Max.
I texted my friend, my mom and my sisters for support. They responded right away, encouraging me to do what I felt was right, reassuring me that Max is and will be a happy and healthy baby. Reminded me that I had tried so hard, done so much already.
I took a photo of the last bottle of breastmilk I fed him. It felt significant given the journey we had taken together. When I checked my instagram later in the day, it happened to be International Breastfeeding Day - a day to celebrate and encourage breastfeeding. What a coincidence!
The last bottle.
Expectations
When I first thought about feeding my baby, I was certain I would be breastfeeding. There was no question. Why not? It’s free, comes right from my body, and it’s human evolution, we’re biologically designed to do it. Also, research suggests it’s better for the child’s and mother’s health. My mom breastfed me and my sisters. My sisters both breastfed their daughters. Naturally, I would breastfeed my baby.
I had no idea at the time how hard it could be, or the types of challenges one might face. Even though I had a good friend who wasn’t able to breastfeed her daughter. I never asked her why, or for more details, because it wasn’t my business and also because she didn’t have to prove anything to me. I was there to support her no matter what.
Her mother-in-law gave her a really hard time about it. Saying that my friend didn’t try hard enough, must not have wanted it, that it was an easy thing to do. I didn’t have that kind of negativity from people around me. But there’s so much out there in books, online, on social media and facebook groups to promote breastfeeding, it sometimes felt like those kinds of negative thoughts were still thrown at me.
What did I hear about breastfeeding during pregnancy?
Breast is Best
The World Health Organization recommends breastfeeding exclusively for the first 6 months, and to continue breastfeeding for the first 2 years of the child’s life.
Breastfeeding is a powerful way of bonding with your child
Breastfeeding brings the baby comfort, reduces stress
Breastfeeding helps Mom lose pregnancy weight and can prevent cancer
Breastfeeding helps shrink the uterus back down after birth.
Your nipples can get sore
What I wish I had heard:
Breastfeeding is the hardest thing you might ever do in your life
It’s only easier (than formula feeding) when it works
Breastfeeding is very emotional, can be stressful if you have latching troubles
There’s a specific technique to latching and it takes a lot of practice.
It can make your arms, wrist and back ache!
Sometimes you need to supplement breastfeeding with formula
If you have to supplement with formula early on, you might be able to scale it back to increase breastfeeding at a future point, or you might not.
Breastfeeding is exhausting
Formula fed kids are healthy too.
Late to the Game
In reality, we had a mix of issues that impacted our breastfeeding experience. Firstly, many women, myself included, find that having a c-section can delay their breast milk “coming in”. My milk didn’t come in until day 5 of Max’s life.
On day 3, we went to see a maternity support worker (MSW) and that’s where we weighed Max to find he had lost 12.1% of his birth weight (up to 7% is acceptable). Under usual circumstances we would have been sent to the hospital. Given the pandemic, they allowed us to stay home. We were given a feeding plan that included feeding more often, and hand-expressing to feed Max a little by spoon so he didn’t exhaust himself sucking away.
Side note, try feeding a 3 day old baby from a little plastic spoon. No way! Tiny baby mouth, he doesn’t understand a spoon. It was not easy. We ended up carefully using a syringe.
A few days later, with his weight not climbing as desired, the MSW provided a pump on loan from the hospital. The instruction was to pump between feeds, 5 mins on each side and then repeat. I struggled to know when to do it though. I was feeding him on each breast for a total of 20 minutes, and then I had to wait at least an hour before pumping. But then I would worry he would wake up hungry again too soon after and I didn’t want to reduce the supply for him. I just was very confused. And also SO, SO TIRED.
It was hard to tell if my supply was increasing. Many of the “experts” we spoke to, and those on the internet, told us that how much you get out when you pump is no indication of how much milk you produce. Your baby is much more efficient at drawing out the milk and can thus access more.
At the end of the first week, we realized we really had to give Max small amounts of formula, because he wasn’t getting enough from me. We chose to do it only at the night feedings, so that I might get some more sleep. The first time Steve fed Max formula, I slept for 4 hours straight. The most since his birth.
When I woke up, I panicked. Where am I? Where’s my baby? Is he OK? Why is my shirt wet? My boobs had leaked and they felt really swollen. I was happy. Look, my boobs work! I leaked, I must have a good supply. I learned later, however, that this is not necessarily a sign of a high supply.
Tongue Tie
Max’s cousin had a tongue tie issue that was diagnosed when he was about a month old. It’s a condition when some skin under the tongue grows extra tight or thick, essentially restricting the movement of the tongue. The tongue is hugely important in a baby's sucking: they use their tongue to press the nipple up against the roof of their mouth to get the milk out. After a procedure to correct it his latching had improved significantly.
The midwives and MSWs said they didn’t see any tongue tie with Max, but we were still curious and made an appointment to see a specialist lactation & tongue tie consultant.
She had a scale of criteria to assess Max on. He scored 9/14; his tongue tie was significant. He couldn’t poke his tongue out of his mouth, and couldn’t touch it to the roof of his mouth. This basically meant that he sucked at sucking. Hence his slow weight gain, feeding for a long time but constant hunger. Breastfeeding is all supply & demand. The more the baby sucks out, the more the body will make. So not sucking out the milk meant my body didn’t see a need to make much more.
We had his tongue tie cut shortly before he was 2 weeks old. The lactation consultant came to my house, assessed Max and did the procedure the same day. She had sterile tools. Steve held Max down and his mouth open, while she made the cut. I had to take before and after photos quickly.
The snapping sound of the scissors against the tight skin, the bright red color of Max’s crying face, and the blood pooling in his mouth are sounds and images that will stay with me for a long time. It was horrible. Steve had to leave the room for a moment afterwards. It had been too traumatic for him. Even today he’s uncomfortable thinking or talking about it.
Max was too upset to nurse, but he calmed down enough to drink some pumped breast milk from a bottle. After a few minutes, he finished. His mouth was no longer bleeding. Over time the diamond shaped wound would heal.
The next day, Max stuck his tongue out of his mouth for the first time in his life. My Mom was really excited. “Look at that tongue!” she beamed. I smiled too, hoping we’d fixed the problem and excited to see our breastfeeding journey kick off to another level.
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| Do I look exhausted?! |
Not Enough
Unfortunately the tongue tie correction wasn’t enough to improve his weight gain. Max’s weight continued to climb s l o w l y. He wasn’t back to birth weight by the time he was 17 days old. We were sent back to the hospital to check him for an infection or dehydration. He had neither. A scrawny, but healthy baby. The pediatrician instructed us to feed him every 3 hours. Breastfeed on one side for 20 minutes, then pump the other side, and top up with formula at every feed.
At this point it was clear formula had to be a big part of feeding Max. She had an equation based on his goal weight (back to birth weight) to calculate how much formula to give him. As he gained weight we could adjust to increase the formula. But my hope was that the pumping would help my supply increase, and eventually we could reduce the formula.
I tried so hard. I fed Max and pumped every 3 hours, day and night for weeks. At night, I would wake up, breastfeed him for 20 minutes, then bottle feed him for at least 20 minutes (he was a slow drinker!). After getting him back to sleep (5-15 mins depending on him!) I’d pump for 20 minutes.
I was awake for at least an hour and a half. Then I had to fall back asleep, which didn’t always come easy. An hour and a half later I would be up again to repeat. If you haven’t had a baby before, imagine getting your sleep in 1.5 hour chunks for weeks. It really takes its toll on you.
It only took a few days to realize I should wake Steve to feed Max the bottle while I pump. It cut down my awake time. Sometimes I could be asleep before he put Max down! Steve struggled to sleep when we were in the same room, so we slept in different rooms. He would get run down, and we needed at least one of us to get decent sleep. He held it together during the day when I was exhausted!
We had a good rhythm, both day and night. I would wake the baby, change him, and nurse. Then Steve or my mom would feed him a bottle while I pumped. Within two days of giving Max formula at every meal his weight gain picked up significantly. By the end of the week he had surpassed his birth weight. It was clearly working for him.
6 Week Deadline
At the breastfeeding basics class I took during pregnancy, I learned that it’s best not to introduce any kind of bottle or formula before 6 weeks. Babies might get “nipple confusion,” where they can’t figure out the switch between breast and bottle. The baby might reject breastfeeding in favor of the bottle, which is much easier to drink from.
Also, any formula fed to your baby is taking the place of breastmilk they might have had. Since breastmilk is demand driven, by feeding baby formula you’re removing that demand on your breasts. I was told that the first 6 weeks are crucial for setting up the supply & demand system between your breasts and brain.
With all this information I was fed, it’s no wonder I agonized over giving Max formula. We had to do it, but I was desperate to slowly wean him off so he would feed more from me. I felt like I was giving up on myself, on Max. I would cry often thinking that I wasn’t doing my best for him. I was already a terrible mother. Steve, my Mom, my Dad, and all the friends I reached out to tried again and again to reassure me that this wasn’t the case. I was/am a great mom, regardless.
Still, I pushed. I asked for advice from so many people on how to increase my supply- the MSW, the lactation consultant, and a couple of people from a free breastfeeding support network. They laid out my options - relax more, keep pumping, try asking your doctor for Domperidone (the champagne of lactation pills, doctors in England are reluctant to prescribe), use a supplemental nursing system, eat lactation cookies, drink a heavy beer like Guinness (not actually a good idea), just start to reduce the formula you offer him.
I did try some of these. Even drinking a Guinness, which I read later was a bit of an old wives tale suggestion. I was never relaxed while nursing. I had to get the position right, the latch right, I was often hunched over and uncomfortable. I got headaches, and was immediately thirsty like I’d never drank before. I tried a lot of things to get more relaxed, including watching Brooklyn 99. My Mom or Steve would bring me food and drinks. Only a few times do I remember actually feeling calm and relaxed though!
I ordered a supplemental nursing system. It’s basically a bag that you fill with formula that leads through a tube that you tape to your nipple. As the baby sucks at the breast they also get formula. The idea is that they get practice at sucking, and close skin to skin time for bonding, while getting the additional nutrition they need. Also, the baby is nursing on me for longer and that will send signals to my brain to produce more milk.
I never did use it though. Steve was convinced that I just wasn’t going to produce more milk without seriously harming my mental health. And that trying to reduce the formula we offer could harm Max’s weight gain and ultimately his health. I thought, maybe he’s right. Did I really want such a hassle to set up this system every time? Would I even be able to increase my supply? I didn’t want to risk messing up Max’s feeding now that it was heading in the right direction. And honestly, since his feeding had improved so had his sleeping and I cherished the rest I could get.
We read about a condition called hypoplasia, when the breasts have insufficient glandular tissue. From what I’ve read many doctors don’t actually know anything about it and it’s not easy to diagnose. There are some common physical signs, a few of which I felt rang true for me. It's a possibility that I might not have enough glandular tissue to produce a strong milk supply.
On the one hand, I didn’t want to believe I had something physically preventing me from being able to supply more breast milk for Max. I thought it was silly to self-diagnose. I told myself that I could do it if I tried harder, tried more of the “tricks” like the SNS or eating lactation cookies. On the flip side, it was sometimes easier to tell myself, it’s not physically possible, I probably have this condition. After all, we tried so many things.
Moving On
It took a really long time to get more comfortable with the formula. Eventually I let go of my attempts to fully breastfeed. It took a lot of encouragement from Steve and others. I kept nursing before he’d drink formula, so it was a comfort to know that he was still getting some food from me.
By the time we got back to Oakland, when Max was three and a half months old, I slowly stopped nursing him. I had realized that I actually didn’t enjoy it. We still had trouble with him latching and staying engaged, and the formula seemed to be the most important contribution to his caloric intake. Plus it would take 45 mins to an hour for a feed. It felt like unnecessary time and hassle.
Once we made the switch to only bottles, he was less fussy and seemed happier. I was happier too. I honestly did not miss it, which was so strange considering how desperate to breastfeed I had been at the beginning. I figured that because I was still pumping, he was still getting breastmilk and that was fine. I would pump twice a day, which got him one bottle of breastmilk every couple of days.
At his 5 month check up the pediatrician told me that Max would need 150ml per day of breastmilk to get the benefits of my immune system. Well he wasn’t getting that. I was expressing about 50-60ml a day. I wondered whether I should increase the frequency I pumped, but I really didn’t want to.
So I kept going for a few weeks until finally that day in early August when I realized, I’d had enough.
All the Emotions
I’ll always remember what my friend in England said, “After 5 years, no one asks whether your kids were breast or formula fed. No one cares and it’s not important.” It’s just so intense in the moment when there’s so much wrapped up around whether or not you breastfeed or formula feed.
I was asked about it at every health visit and always felt a need to explain how challenging breastfeeding had been. Like I had to prove myself to strangers. Even writing this blog I have been extra detailed because I really want people to know how hard I tried, and how dreadful it felt to “fail”.
I hate writing that, that I failed. I shouldn’t have to feel like that. And while this experience wasn’t easy or pleasant for me, I also know moms who had an abundance of milk and came up against other problems. Like infections and blocked ducts, cracked nipples and painful engorgement.
I think back to the first month of Max’s life and it wasn’t full of joy. There were moments of joy, don’t get me wrong. But my memories are of stress, pain, and disappointment. I spent days lost in my anxiety instead of wrapped up in his cute baby face.
I was consuming too many messages that “breast is best” and “you can do it if you try X,Y,Z” from strangers, and not listening enough to the people that love and support me. I wasn’t giving myself a break, I wasn’t being a friend to myself.
I wish there was less pressure on mothers to get breastfeeding “right”, and that more messages communicate that although it’s natural it can definitely be hard, especially at first. I also wish there was more information and support around using formula as an early supplement to help baby while also building the breast milk supply. Instead of the “no formula at all” type approach.
If I have another child, I will attempt to breastfeed again. But, I won’t hold out as long before using formula if they don’t gain weight. And I won’t let myself feel so bad for it. Life’s too short, and these babes grow so fast! Max is so strong, healthy, and adorable right now. He doesn’t love me any less because I stopped breastfeeding him.
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